Dermatology representation in academic clinical gender care programs in the United States: A cross-sectional study
Authors: Soumya A. Reddy, Caroline Fisher, Matthew D. Mansh, J. Klint Peebles
Journal: Journal of the American Academy of Dermatology (2023)

To the Editor: Transgender and gender-diverse (TGD) individuals face significant disparities in health care access and outcomes, resulting in delays in care or avoidance of the health care system for fear of discrimination.1Grant J.M. Tanis M.J. Harrison J. Herman J.L. Keisling M. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. National Center for Transgender Equality and National Gay and Lesbian Task Force, 2011Google Scholar Multispecialty gender care programs have been developed across many health care systems in the United States to meet the needs of TGD people in a safe and affirming environment amid a growing demand for care from knowledgeable physicians. Dermatologists play a vital role in gender-affirming care, including, but not limited to, minimally invasive gender-affirming procedures and management of complications related to hormone therapy.2Ginsberg B.A. Calderon M. Seminara N.M. Day D. A potential role for the dermatologist in the physical transformation of transgender people: a survey of attitudes and practices within the transgender community.J Am Acad Dermatol. 2016; 74: 303-308https://doi.org/10.1016/j.jaad.2015.10.013Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar However, the extent of dermatologic representation within multispecialty gender care programs remains unknown. The purpose of this study is to assess the current representation of dermatology within academically affiliated gender care programs in the United States to determine gaps in dermatologic care for TGD individuals. We conducted a cross-sectional review of 145 Accreditation Council for Graduate Medical Education–accredited dermatology residency programs in the United States. A web-based search from April 2023 to August 2023 was performed to identify public-facing information about organized gender care programs within the respective institutions affiliated with those dermatology residency programs. For the purposes of this study, representation was defined as any mention of dermatologic services offered by the institutional multispecialty gender program in association with the affiliated dermatology department, including explicit referral relationships. The physical location of dermatologic services relative to the gender program was not considered relevant as not all multispecialty gender care programs share common spaces. Programs without affiliations with gender care programs or those affiliated with nonmultispecialty gender care programs (ie, those not offering both medical and surgical services OR medical services from at least 2 subspecialties) were excluded (Fig 1). Seventy-four of 145 (51.0%) dermatology residency programs were affiliated with a multispecialty gender program. Of those, 22 of 74 (29.7%) described dermatologic services as an offering by their institutional dermatology department. Fourteen of the 74 gender programs offered dermatology services through a nondermatology specialty (eg, plastic surgery) or did not specify a clinician or specialty. Detailed characteristics of these integrated gender care programs are outlined in Table I.Table ICharacteristics of dermatology residency programs with dermatology available in their multispecialty gender program∗Dermatology residency programs (DRP) with multiple affiliated hospitals and/or more than 1 affiliated gender program (eg, pediatric and adult programs associated with the same DRP) were considered as a single gender program-DRP combination.List of 22 included residency programsBoston University Medical Center ProgramOhio State University Hospital ProgramCleveland Clinic Foundation ProgramStanford Health Care-Sponsored University ProgramDuke University Hospital ProgramUniversity of California (San Diego) Medical CenterEmory University School of Medicine ProgramUniversity of Colorado ProgramHenry Ford Hospital ProgramUniversity of Iowa Hospitals and Clinics ProgramIcahn School of Medicine at Mount Sinai ProgramUMass Chan Medical School ProgramJohns Hopkins University ProgramUniversity of Michigan Health System ProgramMassachusetts General Hospital/Beth Israel Deaconess Medical Center/Brigham and Women's Hospital ProgramUniversity of Southern California/LAS + USC Medical CenterMcGaw Medical Center of Northwestern University ProgramDartmouth-Hitchcock/Mary Hitchcock Memorial HospitalMedical College of Wisconsin Affiliated Hospitals ProgramWashington University/B-JH-SLCH Consortium ProgramUniversity of Pennsylvania Health SystemOregon Health & Science University ProgramResidency program characteristic (N = 22)N (%)AAMC-designated residency region Central8 (36%) Northeast7 (32%) Southern2 (9%) Western5 (23%)Total number of dermatologists listed by name in the associated gender program(s) 112 (55%) 21 (5%) 31 (5%) Unable to determine or nonphysician†Some clinics did not list any or all clinicians and or offered dermatology services through a physician assistant.8 (36%)Patient ages treated Adults only4 (18%) Both adolescents and adults‡The specific age range for "adolescents" was not specified by all clinics.13 (59%) Adolescents only0 (0%) Unable to determine5 (23%)Dermatologic services offered§DRP may offer more than 1 type of dermatologic service. Hair removal‖Details of hair removal site or context (eg, face, body, presurgical, etc.) were not listed.10 (40%) Acne management4 (25%) Alopecia management4 (15%) Neurotoxins2 (5%) Soft tissue augmentation2 (5%) Body sculpting1 (5%) "Sun damage" conditions1 (5%) No specific services described4 (45%)∗ Dermatology residency programs (DRP) with multiple affiliated hospitals and/or more than 1 affiliated gender program (eg, pediatric and adult programs associated with the same DRP) were considered as a single gender program-DRP combination.† Some clinics did not list any or all clinicians and or offered dermatology services through a physician assistant.‡ The specific age range for "adolescents" was not specified by all clinics.§ DRP may offer more than 1 type of dermatologic service.‖ Details of hair removal site or context (eg, face, body, presurgical, etc.) were not listed. Open table in a new tab Our study is limited to publicly available information through the programs' respective websites. Dermatology departmental affiliation with these programs may not be explicitly stated online, and websites may not be updated to reflect current clinicians and services. Additionally, current state-based legislative restrictions on gender-affirming care, particularly adolescent care, have impacted the availability and visibility of certain programs. Nonetheless, convenient and transparent access to such information is critical for TGD individuals seeking safe, comprehensive gender care.3Evans Y.N. Gridley S.J. Crouch J. et al.Understanding online resource use by transgender youth and caregivers: a qualitative study.Transgend Health. 2017; 2: 129-139https://doi.org/10.1089/trgh.2017.0011Crossref PubMed Scopus (69) Google Scholar Our study highlights potential gaps in access to dermatologic care within organized gender programs at academic institutions in the United States. Incorporation of dermatology into multispecialty gender care programs can expand accessibility and quality of care for TGD people seeking gender-affirming care while expanding TGD medical education for residents in a more intentional and explicit manner.4Carlson K.J. Irwin J.A. Dowdall J.R. Figy S.C. Amoura N.J. Integrated comprehensive care for transcare and gender diverse clinic patients: an assessment of physical, mental, and social needs.Cureus. 2021; 13e20544https://doi.org/10.7759/cureus.20544Crossref Google Scholar,5Juarez P.D. Ramesh A. Reuben J.S. et al.Transforming medical education to Provide gender-affirming care for transgender and gender-diverse Patients: a Policy brief.Ann Fam Med. 2023; 21: S92-S94https://doi.org/10.1370/afm.2926Crossref PubMed Scopus (6) Google Scholar Thus, dermatology programs should encourage collaboration with available institutionally affiliated gender programs and maximize transparency of such efforts to address existing health care inequities for TGD individuals. None disclosed.